Children Court Area of ........................................ District No.

In the matter of ................................. a child

.............. of ............. Applicant

.............. of ............. Respondent

Whereas the child referred to above is in the care of the Health Service Executive under *section 4 *section 18 of the Child Care Act 1991 and has been placed with the applicant *under section 36(1)(a) of the said Act as foster parent *under section 36(1)(d) of the said Act as a relative.

Take notice that the applicant will apply to the sitting of the Children Court to be held at.......... on the ..... day of ..... 20 .. . at ...... am/pm for an order under section 43A of the Child Care Act 1991.

The consent of the Health Service Executive under section 43A(2)(c) of the Act to the granting of the order is appended to this notice of application.

Dated this .... day of ....... 20 ...

Signed ...................

Applicant/Solicitor for the applicant

To...................

of .....................

Respondent(s)

And to District Court Clerk at .....................

*Delete words inapplicable

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